Liver transplant practices in the era of normothermic machine perfusion in the United States

doi:10.5500/wjt.v15.i2.100427

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Transplant. Jun 18, 2025; 15(2): 100427
Published online Jun 18, 2025. doi: 10.5500/wjt.v15.i2.100427

Liver transplant practices in the era of normothermic machine perfusion in the United States

Kenji Okumura, Abhay Dhand, Bima J Hasjim, Ryosuke Misawa, Hiroshi Sogawa, Gregory Veillette, Seigo Nishida

Kenji Okumura, Abhay Dhand, Ryosuke Misawa, Hiroshi Sogawa, Gregory Veillette, Seigo Nishida, Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States

Bima J Hasjim, Department of Surgery, University of California, Irvine Medical Center, Orange, CA 92697, United States

Author contributions: Okumura K, Misawa R, Nishida S contributed to concept design; Okumura K, Dhand A, Misawa R, Nishida S contributed to data analysis interpretation; Okumura K, Dhand A, Nishida S contributed to drafting article; Okumura K, Dhand A, Misawa R, Sogawa H, Veillette G contributed to critical revision of article.

Institutional review board statement: This study was approved by our local Institutional Review Board.

Informed consent statement: Informed consent is waived.

Conflict-of-interest statement: All the authors of this manuscript declare no funding or conflicts of interest to disclose.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.

Data sharing statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Corresponding author: Kenji Okumura, MD, Assistant Professor, Department of Surgery, Westchester Medical Center, 100 Woods Rd, Valhalla, NY 10595, United States. kenji.okumura@wmchealth.org

Received: August 18, 2024
Revised: December 5, 2024
Accepted: December 27, 2024
Published online: June 18, 2025
Processing time: 189 Days and 9 Hours

Abstract

BACKGROUND

Normothermic liver machine perfusion (NMP) is a novel technology used to preserve and evaluate the function of liver allografts.

AIM

To assess NMP utilization in liver transplant (LT) practices.

METHODS

All adult deceased-donor LT recipients between January 2021 and September 2023 in the United States were analyzed. Outcomes including discard rates, survival, preservation time and timing of surgery were compared between two groups: NMP vs non-NMP.

RESULTS

Between 2021 and 2023, NMP was utilized in 1493 (6.3%) of all LTs in the United States. Compared to non-NMP group, NMP group had lower allograft discard rate (6.5% vs 10%, P < 0.001), older recipients’ age (median: 47 vs 42 years, P < 0.001), and higher utilization of donors from donation after circulatory death (DCD) (55% vs 11%, P < 0.001). NMP group also had longer distances between recipient and donor hospitals (median: 156 vs 138 miles, P < 0.001), longer preservation time (median: 12.2 vs 5.8 hours, P < 0.001), and more daytime reperfusion (74% vs 55%, P < 0.001). Post-transplant survival outcomes were comparable between the two groups. In a subgroup analysis of NMP, recipients in the long preservation time (≥ 8 hours) group had higher daytime reperfusion (78% vs 55%, P < 0.001) and similar post-transplant survival when compared to the short preservation time (< 8 hours) group.

CONCLUSION

The utilization of NMP is associated with lower discard rates and increased DCD organs for LT. NMP allows for prolonging the preservation time and increased occurrence of daytime LT, without any impact on the survival outcomes.

Keywords: Liver transplant; Machine perfusion; Daytime; Distance

Core Tip: The utilization of normothermic liver machine perfusion is associated with lower discard rates, increased utilization of donation after circulatory death liver allografts and an ability to expand the distance between recipient and donor hospitals, prolong preservation time, and higher occurrence of daytime liver transplant without any negative impact on the survival outcomes.